IMPROVING EFFICACY OF DRUG ABUSE TREATMENT

这份申请是为了申请以患者为中心的研究的职业中期研究员奖(K24)，以便在接下来的五年里，我可以主要专注于临床研究、写作和指导初学者。我的研究旨在通过临床试验和临床流行病学研究，提高药物滥用治疗的可及性、可用性和有效性。我的研究和方法的总主题在我的两个主要研究项目中显而易见，调查阿片类激动剂维持治疗的药理学和行为成分，以及调查可卡因依赖孕妇和有年幼子女的妇女的治疗方法。药物滥用和医疗服务的协调和整合一直是这项研究探索的一项重要战略，当前的项目和拟议获奖期计划的临床研究就是例证。这些研究包括对初级保健诊所丁丙诺啡维持情况的评估，对稳定的美沙酮维持患者的医疗维持，以及对产前和儿科诊所确定的可卡因依赖妇女的行为治疗。后一项研究是拟议授标最初几年计划的主要项目之一，在本申请书中有更全面的说明。这项研究是一项2X2的临床试验，比较了基于12步模型的两种手动指导治疗，社区强化方法(CRA)和药物咨询(DC)，并比较了使用凭证程序奖励戒烟的应急管理(CM)和带枷锁的非或有凭证控制(VC)。近十年来，我在任何时候都会参与2到4项外部资助的研究。我预计在未来至少保持这种水平的支持，特别是如果我获得K24奖，从而能够解除我现在大部分重要的临床和管理责任。我的临床研究和指导活动得益于耶鲁大学在药物滥用方面广泛的临床研究、教学和临床项目，这些项目也为招募需要指导的初学者提供了绝佳的机会，并为培训他们提供了肥沃的环境。我有相当多的培训和指导初级研究人员的经验，目前我正在指导四名新近任命的教职员工和一名博士后实习生。因此，K24奖项将为我提供一个关键的机会，以提高我自己的临床研究事业，并投入更多的时间指导初学者，正如本申请所建议的那样。

This application is for a Midcareer Investigator Award in Patient-Oriented Research (K24) so that over the next five years I can focus predominantly on clinical research, writing and mentoring beginning investigators. My research has been aimed at improving the accessibility, availability and efficacy of substance abuse treatment through clinical trials and clinical epidemiologic studies. The general themes of my research and approaches utilized are evident in my two major research programs, investigating pharmacologic and behavioral components of opioid agonist maintenance treatment and investigating treatments for cocaine dependent pregnant women and women with young children. Coordination and integration of substance abuse and medical services has been one important strategy explored in this research, as exemplified by current projects and clinical research planned for the proposed award period. These studies include evaluation of buprenorphine maintenance in a primary care clinic, medical maintenance for stabilized methadone maintained patients, and behavioral treatments for cocaine-dependent women identified in prenatal and pediatric clinics. The latter study is one of the major projects planned for the initial years of the proposed award and is described more fully in this application. The study is a 2X2 clinical trial comparing two manual-guided treatments, Community Reinforcement Approach (CRA) and Drug Counseling (DC) based on a 12-step model, and comparing Contingency Management (CM) using a voucher procedure to reward abstinence and a yoked, non-contingent Voucher Control (VC). For nearly a decade, I have been PI on between 2 and 4 externally funded studies at any time. I anticipate maintaining at least this level of support in the future, especially if I receive a K24 award and am thus able to be relieved of most of my now substantial clinical and administrative responsibilities. My clinical research and mentoring activities are facilitated by the extensive clinical research, teaching and clinical programs in drug abuse at Yale which also provide outstanding opportunities for recruitment of beginning investigators needing mentoring and a fertile environment for training them. I have had considerable experience training and mentoring beginning investigators and I am currently mentoring four recently appointed faculty members and one post-doctoral trainee. A K24 award would thus provide a critical opportunity for me to enhance my own clinical research career and devote more time to mentoring beginning investigators, as proposed in this application.